THIS JOINT NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Joint Notice is being provided to you on behalf of Northern Westchester Hospital and its Professional Staff (collectively referred to herein as “We” or “Our”). We understand that your medical information is private and confidential. Further, we are required by law to maintain the privacy of “protected health information.” “Protected health information” includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. Northern Westchester Hospital and its Professional Staff will share protected health information with one another, as necessary, to carry out treatment, payment or health care operations relating to the services to be rendered at Hospital facilities.
As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of protected health information. This notice also discusses the uses and disclosures we will make of your protected health information. We must comply with the provisions of this notice as currently in effect, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all protected health information we maintain. You can always request a written copy of our most current privacy notice from the Medical Records Department at the Hospital or you can access it on our website at www.nwhc.net
PERMITTED USES AND DISCLOSURES
We can use or disclose your protected health information for purposes of treatment, payment and health care operations. For each of these categories of uses and disclosures, we have provided a description and an example below. However, not every particular use or disclosure in every category will be listed.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
In addition to using and disclosing your information for treatment, payment and health care operations, we may use your protected health information in the following ways:
Note: In accordance with applicable law, we may disclose your protected health information to your employer if we are retained to conduct an evaluation relating to medical surveillance of your workplace or to evaluate whether you have a work-related illness or injury. Your employer or the Hospital, as required by applicable law will notify you of these disclosures.
Subject to the requirements of applicable law, we will make the following uses and disclosures of your protected health information:
Organ and Tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the Armed Forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
Worker’s Compensation. We may release health information about you for programs that provide benefits for work-related injuries or illnesses.
Public Health Activities. We may disclose health information about you for public health activities, including disclosures:
Health Oversight Activities. We may disclose health information to Federal or State agencies that oversee our activities. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws or regulatory program standards.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order or if you authorize the disclosure.
Law Enforcement. We may release health information if asked to do so by a law enforcement official:
Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner. Such disclosures may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may release health information about you to authorized Federal officials for intelligence, counterintelligence, or other national security activities authorized by law.
Protective Services for the President and Others. We may disclose health information about you to authorized Federal officials so they may provide protection to the President or other authorized persons or foreign heads of state or may conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Serious Threats. As permitted by applicable law and standards of ethical conduct, we may use and disclose protected health information if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or is necessary for law enforcement authorities to identify or apprehend an individual.
Note: HIV-related information, genetic information, alcohol and/or substance abuse records, mental health records and other specially protected health information may enjoy certain special confidentiality protections under applicable State and Federal law. Any disclosures of these types of records will be subject to these special protections.
OTHER USES OF YOUR HEALTH INFORMATION
Other uses and disclosures of protected health information not covered by this notice or the laws that apply to us will be made only with your permission in a written authorization. You have the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we already have taken action in reliance on your authorization.
(i) for psychotherapy notes, which are notes that have been recorded by a mental health professional documenting or analyzing the contents of conversations during a private counseling session or a group, joint or family counseling session and that have been separated from the rest of your medical record;
(ii) for information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding;
(iii) for protected health information involving laboratory tests when your access is restricted by law;
(iv) for the Hospital’s directory or to persons involved in your care or for other notification purposes as provided by law;
(v) if you are a prison inmate, obtaining a copy of your information may be restricted if it would jeopardize your health, safety, security, custody, or rehabilitation or that of other inmates, or the safety of any officer, employee, or other person at the correctional institution or person responsible for transporting you;
(vi) if we obtained or created protected health information as part of a research study, your access to the health information may be restricted for as long as the research is in progress, provided that you agreed to the temporary denial of access when consenting to participate in the research;
(vii) for protected health information contained in records kept by a Federal agency or contractor when your access is restricted by law; and
(viii) for protected health information obtained from someone other than us under a promise of confidentiality when the access requested would be reasonably likely to reveal the source of the information.
In order to inspect and copy your health information, you must submit your request in writing to the (Manager of Medical Records) at our Hospital. If you request a copy of your health information, we may charge you a fee for the costs of copying and mailing your records, as well as other costs associated with your request.
We may also deny a request for access to protected health information if:
4. You have the right to request an amendment to your protected health information, but we may deny your request for amendment, if we determine that the protected health information or record that is the subject of the request:
(i) was not created by us, unless you provide a reasonable basis to believe that the originator of protected health information is no longer available to act on the requested amendment;
(ii) is not part of your medical or billing records or other records used to make decisions about you;
(iii) is not available for inspection as set forth above; or
(iv) is accurate and complete.
In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records. In order to request an amendment to your health information, you must submit your request in writing to the (Manager of Medical Records) at our Hospital, along with a description of the reason for your request.
5. You have the right to receive an accounting of disclosures of protected health information made by us to individuals or entities other than to you for the six prior years, except for disclosures:
(i) to carry out treatment, payment and health care operations as provided above;
(ii) incidental to a use or disclosure otherwise permitted or required by applicable law;
(iii) pursuant to a written authorization obtained from you;
(iv) for national security or intelligence purposes as provided by law;
(v) to correctional institutions or law enforcement officials as provided by law;
(vi) as part of a limited data set as provided by law; or
(vii) that occurred prior to April 14, 2003.
To request an accounting of disclosures of your health information, you must submit your request in writing to the (Manager of Medical Records) at our Hospital. Your request must state a specific time period for the accounting (e.g. the past three months). The first accounting you request within a twelve (12) month period will be free. For additional accountings, we may charge you for the costs of providing the list. We will notify you of the costs involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
If you believe that your privacy rights have been violated, you should immediately contact Debbie Pirchio, Privacy Officer at 914.666.1866. We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of Health and Human Services.
If you have any questions or would like further information about this notice, please contact Debbie Pirchio, Privacy Officer at 914.666.1866.
This notice is effective as of April 14, 2003.
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